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Medicare and the care of First Nations, Métis and Inuit

  • Josée G. Lavoie (a1)


The Canada Health Act 1984 (CHA) is considered foundational to Canada’s publicly funded health care system (known as Medicare). The CHA provides for the federal transfer of funding to the provinces/territories, in exchange for provincial/territorial adherence to Medicare’s key principles of universality; comprehensiveness; portability; accessibility; and, public administration. Medicare is a decentralized health care system, managed independently by Canada’s 10 provincial and three territorial governments, allowing for regional adaptations to fit varying degrees of urbanity, remoteness and needs. The Act is silent on its relationship to the Indigenous health care system – what some have described as Canada’s 14th health care system. The CHA has not kept pace with Indigenous self-government activities that have since spread across Canada. It has unfortunately crystallized the federal/provincial/territorial/Indigenous jurisdictional fragmentation that perpetuates health inequities and has failed to clarify these jurisdictions’ obligations towards Indigenous peoples. As a result of these omissions, access to health services remains a concern for many Indigenous Canadians, resulting in poorer outcomes and premature mortality. In this paper, I argue that Medicare renewal must: make an explicit commitment to Indigenous health equity; clarify jurisdictional obligations; establish effective mechanisms for addressing areas of jurisdictional dispute and/or confusion; and explicitly recognize First Nations and Inuit health care services as integral yet distinct systems, that nevertheless must be welcomed to seamlessly work with provincial health care systems to ensure continuity of care.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

*Correspondence to: Professor Josée G. Lavoie, Department of Community Health Sciences and Director, University of Manitoba, Ongomiizwin Research, #715, 727 McDermot Avenue, Winnipeg, Manitoba, R3E 3P4, Canada. Email:


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Auditor General of Canada (1982), ‘Department of National Health and Welfare’. Auditor General of Canada. Office of the Auditor General of Canada, Ottawa.
Auditor General of Canada (2015), ‘Report 7, establishing the First Nations Health Authority in British Columbia’, Office of the Auditor General of Canada, Ottawa.
Barron, F. L. (1997), Walking in Indian Mocassins: The Native Policies of Tommy Douglas and the CCF, Vancouver, BC: UBC Press.
Bartlett, J. G., Sanguins, J., Carter, S., Hoeppner, N. and Mehta, P. (2010), Diabetes and Related Health Care Utilization in the Metis Population in Manitoba, Winnipeg, MB: Manitoba Metis Federation.
Bégin, The Honourable Monique (1981), ‘Discussion paper: transfer of health services to Indian communities’, Ottawa.
Booz Allen & Hamilton Canada Ltd (1969), Study of Health Services for Canadian Indians, Ottawa: Booz Allen & Hamilton Canada Ltd .
Boyer, Y. (2004), ‘The International Right to Health for Indigenous Peoples in Canada’. Discussion Paper Series on Aboriginal Health, Legal Issues: No. 3, National Aboriginal Health Organization, Ottawa.
Boyer, Y. (2014), Moving Aboriginal Health Forward: Discarding Canada’s Legal Barriers, Saskatoon, SK: Purich Publishing Ltd.
Boyer, Y., Lavoie, J. G., Kornelsen, D. and Reading., J. (2017), ‘20 Years later: RCAP’s legacy in Indigenous health system’s governance – What about the next twenty?’, RCAP 20 Forum, Winnipeg, MB.
British Columbia Provincial Health Officer (2009), ‘Pathways to health and healing – 2nd report on the health and well-being of Aboriginal people in British Columbia’, Provincial Health Officer’s Annual Report 2007, Victoria, BC.
British Columbia Royal Commission on Health Care and Costs (1991), ‘Closer to home: the report of the British Columbia Royal Commission on health care and costs’, Victoria, BC.
Brittain, W. B. (1959), ‘The impact of hospital insurance on Indian Health Services’, Medical Services Journal, 15: 632634.
Canada (1974), The James Bay and Northern Quebec Agreement (JBNQA), Ottawa: Government of Canada.
Canada (1982), ‘The Constitution Act’, 1982, being Schedule B to the Canada Act 1982 (U.K.), 1982, c. 11.
Canada (1985), ‘Indian Act (R.S., 1985, c. I-5)’.> [12 November 2017].
Canada (2004), ‘Canada Health Act’, RSC 1985, c C-6, [12 November 2017].
Canada (2016), ‘Daniels v. Canada (Indian Affairs and Northern Development): Supreme Court Judgments’. Supreme Court Judgments, Ottawa.
Carrière, G., Bougie, E., Kohen, D., Rotermann, M. and Sanmartin, C. (2016), Acute Care Hospitalization by Aboriginal Identity, Canada, 2006 Through 2008, Ottawa: Statistics Canada.
Crombie, The Honourable David (1979), ‘Statement on Indian Health Policy’. Ottawa.
Dacks, G. (1990), Devolution and Constitutional Development in the Canadian North, Ottawa: Carleton University Press. (Reprint, Not in File).
Dion Stout, M. and Kipling, G. D. (2002), Sharing the Learning: The Health Transition Fund, Synthesis Series, Aboriginal Health, Ottawa: Health Canada.
First Ministers and National Aboriginal Leaders (2005), ‘Strengthening relationships and closing the gap, Kelowna, British Columbia’, 24–25 November, Government of Canada, Ottawa.
First Nations Health Council, Government of Canada, and Government of British Columbia (2010), ‘British Columbia Tripartite First Nations Health: basis for a framework agreement on health governance’, Victoria, BC.
Gallagher, J., Mendez, J. K. and Kehoe, T. (2015), ‘The First Nations Health Authority: a transformation in healthcare for BC First Nations’, Healthcare Management Forum, 28(6): 255261.
Gouvernement du Québec (1987), ‘Commission d’enquête sur les services de santé et les services sociaux’, Gouvernement du Québec, Québec.
Government of Alberta (1989), ‘The Rainbow Report, Volume II, Premier’s Commission on Future Health Care for Albertans’, Government of Alberta, Edmonton, AB.
Government of Canada (1998), ‘Canada health action: building on the legacy – Volume I – the Final Report’, Government of Canada, Ottawa.
Government of Canada (2004), ‘First Ministers’ Meeting on the Future of Health Care: a 10 year plan to strengthen health care’, Government of Canada, Ottawa.
Government of Ontario (1987), ‘Towards a shared directions for health in Ontario’, Government of Ontario, Toronto, ON.
Health Canada (FNIHB) (2008a), ‘Contribution funding framework and agreement modification’, Ottawa.
Health Canada (FNIHB) (2008b), ‘Transfer status as of March 2008’, Ottawa.
Health Canada (MSB) (1995), ‘Pathways to First Nation control, report of project 07, strategic planning exercise’, 1995 Final Report, Ottawa.
Higgins, J. (2009), ‘Aboriginal people and confederation’, Newfoundland and Labrador Heritage, St John’s, NL.
The Jordan’s Principle Working Group (2015), ‘Without denial, delay, or disruption: ensuring First Nations children’s access to equitable services through Jordan’s Principle’, Assembly of First Nations, Ottawa.
Kelly, M. D. (2011), ‘Toward a new era of policy: health care service delivery to First Nations’, The International Indigenous Policy Journal, 2(1): 112.
Kirby, The Honourable Senator Michael JL (2002), ‘The health of Canadians – the federal role’, Ottawa.
Lavoie, J. G. (2016), ‘A comparative financial analysis of the 2003-04 and 2009-10 health care expenditures for First Nations in Manitoba’, Unpublished Manuscript, MFN-Centre for Aboriginal Health Research, Winnipeg, MB.
Lavoie, J. G., Kornelsen, D., Boyer, Y. and Wylie, L. (2016a), ‘Lost in maps: regionalization and Indigenous health services’, HealthcarePapers, 16(1): 6373.
Lavoie, J. G., Kaufert, J. M., Browne, A. and O’Neil, J. D. (2016b), ‘Managing Matajoosh: determinants of First Nations’ cancer care decisions’, BMC Health Services Research, 16(402): 112.
Lavoie, J. G., Gervais, L., Toner, J., Bergeron, O. and Thomas, G. (2013), ‘Aboriginal health policies in Canada: the policy synthesis project’, Prince George, BC.
Lavoie, J. G., Joseph, M. K., Browne, A. J., Mah, S. and O’Neil, J. D. (2015), ‘Negotiating barriers, navigating the maze: First Nation peoples’ experience of medical relocation’, Canadian Public Administration, 58(2): p. 295–314.
Lavoie, J. G., Forget, E. L., Prakash, T., Dahl, M., Martens, P. J. and O’Neil, J. D. (2010), ‘Have investments in on-reserve health services and initiatives promoting community control improved First Nations’ health in Manitoba?’, Social Science and Medicine, 71(4): 717724.
Lavoie, J. G., O’Neil, J., Sanderson, L., Elias, B., Mignone, J., Bartlett, J., Forget, E., Burton, R., Schmeichel, C. and MacNeil, D. (2005), ‘The evaluation of the First Nations and Inuit Health Transfer Policy’, Winnipeg, MB.
Lux, M. K. (2010), ‘Care for the “racially careless”: Indian hospitals in the Canadian West, 1920-1950s’, Canadian Historical Review, 91(3): 407434.
Lux, M. K. (2016), Separate Beds: A History of Indian Hospitals in Canada, 1920s–1980s, Toronto, ON: University of Toronto Press.
Madore, Odette (1991), ‘Established programs financing for health care’, Government of Canada, Economic Division, BP-264-E, Ottawa.
Martens, P. J., Bartlett, J. G., Prior, H. J., Sanguins, J., Burchill, C. A., Burland, E. M. and Carter, S. (2011), ‘What is the comparative health status and associated risk factors for the Metis? A population-based study in Manitoba, Canada’, BMC Public Health, 11: 814.
Martens, P. J., Bartlett, J., Burland, E., Prior, H., Burchill, C., Huq, S., Romphf, L., Sanguin, J. and Bailly, A. (2010), ‘Profile of Metis health status and healthcare utilization in Manitoba: a population-based study’, Winnipeg, MB.
Mhatre, S. L. and Deber, R. B. (1992), ‘From equal access to health care to equitable access to health: a review of Canadian health commissions and reports’, International Journal of Health Services, 22(4): 645668.
National Advisory Committee on SARS and Public Health (2003), Learning from SARS - Renewal of Public Health in Canada, A report of the National Advisory Committee on SARS and Public Health October 2003. Ottawa.
O’Neil, J., Gallagher, J., Wylie, L., Bingham, B., Lavoie, J. G., Alcock, D. and Johnson, H. (2016), ‘Transforming First Nations’ health governance in British Columbia’, International Journal of Health Governance, 21(4): 229244.
Ontario Minister of Health (1994), New Directions: Aboriginal Health Policy for Ontario, Toronto, ON: Ministry of Health.
Patterson, L. L. (2006), ‘Aboriginal roundtable to Kelowna Accord: Aboriginal policy negotiations, 2004-2005’, Political and Social Affairs Division, Parliamentary Information and Research Service, Library of Parliament, Ottawa.
Romanow, C. R. J. (2002), ‘Building on values, the future of health care in Canada’, Final Report, Ottawa.
Royal Commission on Aboriginal Peoples (RCAP) (1996a), ‘People to people, nation to nation: highlights from the Report of the Royal Commission on Aboriginal Peoples’, Minister of Supply and Services Canada, Ottawa.
Royal Commission on Aboriginal Peoples (RCAP) (1996b), ‘Volume 5 - a twenty year commitment’, Ottawa.
Shah, B. R., Gunraj, N. and Hux, J. E. (2003), ‘Markers of access to and quality of primary care for Aboriginal People in Ontario, Canada’, American Journal of Public Health, 93(5): 798802.
Stevenson, H. M., Williams, A. P. and Vayda, E. (1988), ‘Medical politics and Canadian Medicare: professional response to the Canada Health Act’, Milbank Q, 66(1): 65104.
Swain, H. (2010), Oka: A Political Crisis and its Legacy, Madeira Park, BC: D & M Publishers.
Titley, E. B. (2009), The Indian Commissioners: Agents of the State and Indian Policy in Canada’s Prairie West, 1873-1932, Edmonton, AB: University of Alberta Press.
Truth and Reconciliation Commission (2015), What We Have Learned: Principles of Truth and Reconciliation, Ottawa: Truth and Reconciliation Commission of Canada.
Truth and Reconciliation Commission of Canada (2015), Honouring the Truth, Reconciling for the Future Summary of the Final Report of the Truth and Reconciliation Commission of Canada, Ottawa: Truth and Reconciliation Commission of Canada.
Waldram, J. B., Herring, D. A. and Young, T. K. (2006), Aboriginal Health in Canada: Historical, Cultural and Epidemiological Perspectives, 2nd edn, Toronto, ON: University of Toronto Press.
Weaver, S. (1971), ‘Smallpox and chickenpox: an Iroquoian community’s reaction to crisis, 1901-1902’, Ethnohistory, 18: 361378.

Medicare and the care of First Nations, Métis and Inuit

  • Josée G. Lavoie (a1)


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